At a Glance

Why Get Tested?

Most often, to screen for infections in women with the types of HPV that are associated with cervical cancer or to follow up on an abnormal Pap smear; sometimes to detect an HPV infection in men as there is a potential correlation between HPV infection and anal or penile cancer

When to Get Tested?

If you are a woman age 30 or older; if you are a woman 21 years or older and have an abnormal Pap smear; if you are a man at high risk for HPV infection

Sample Required?

In females, the test requires a sampling of cells from the cervical area. In males, the necessary sample involves anal swabs or brush specimens. Currently, there are no tests approved by the Food and Drug Administration (FDA) to detect HPV in males; however, some specialty labs have validated DNA tests for analyzing anal swabs from males.

Test Preparation Needed?

It is recommended that you do not douche or tub bathe before the test. Reschedule the test if you are menstruating. You may be asked to empty your bladder before the examination. Some doctors may request that you refrain from sex for 24 to 48 hours before the test.

The Test Sample

What is being tested?

Human papillomavirus (HPV) is a group of about 100 related viruses. Some types can cause skin warts while other types can cause genital warts (also called condylomata). Common in young women and men, most HPV infections that are spread through oral, anal or genital sex are short-lived and relatively benign. There are, however, several types of HPV (such as HPV-16, HPV-18, HPV-31, and HPV-45) that are considered high-risk. They do not usually cause visible warts, but persistent infections have been linked to cervical cancer as well as other less common cancers, such as of the vagina, mouth, throat, penis, and anus. The HPV DNA test detects the genetic material of the high-risk types of HPV associated with cancer. Some of the genetic tests detect the types that are low-risk and cause warts, but they are generally not recommended for that purpose.

Genital HPV is one of the most common sexually transmitted diseases in the world. According to the U.S. Centers for Disease Control and Prevention, 20 million people in this country are infected with HPV and over 6 million become newly infected each year. At least 50% of sexually active women and men contract HPV at some point in their lives. HPV that cause genital warts can be diagnosed through visual inspection and therefore do not require testing. High-risk types that have been associated with cancer can be diagnosed with an HPV DNA test.

Persistent infections with certain types of HPV are now known to be the major risk factor for cervical cancer. HPV types 16 and 18 account for about 70% of cervical cancers in the U.S. Each year, more than 12,000 women in the U.S. develop cervical cancer and about 4,200 die from it. In addition, some studies have also shown that persistent oral infections with high-risk types of HPV are strongly associated with oral cancers, including cancer of the mouth and throat. Anal cancer has also been linked to HPV types 16 and 18.

How is the sample collected for testing?

A sampling of cells is taken from the cervical area in females during a pelvic examination using a type of wooden "spatula," swab, or brush. If HPV DNA testing is to be performed, the sample is placed into a special liquid preservative. HPV tests may also be ordered on male patients; an anal swab or brush specimen is used for testing.

Another article, Follow That Sample, provides a glimpse at the collection and processing of a blood sample and throat culture.

Is any test preparation needed to ensure the quality of the sample?

It is recommended that you do not douche or tub bathe before the test, and you should reschedule the test if you are menstruating. You may be asked to empty your bladder before the examination. Some doctors may request that you refrain from sex for 24 to 48 hours before the test.

The Test

How is it used?

Traditionally, genital HPV infection has been detected as abnormal cell changes on a Pap smear, a test used primarily to detect cancer of the cervix (the lower part of the uterus or womb) or conditions that may lead to cancer. During a Pap smear, the appearance of cervical cells is evaluated under a microscope. Certain changes in the cells may indicate an HPV infection, but there is no clear distinction between high- and low-risk types.

DNA testing for HPV can be used as a follow-up to abnormal changes detected with a Pap smear. Guidelines from several organizations now recommend that HPV DNA tests be ordered along with a Pap smear for women 30 to 65 years of age. There are several DNA HPV tests, some approved for marketing by the FDA, that can detect high-risk types of HPV.

When is it ordered?

The American College of Obstetricians and Gynecologists (ACOG), the U.S. Preventive Services Task Force (USPSTF), and the American Cancer Society (ACS) now recommend HPV testing as part of routine cervical cancer screening for women 30 to 65 years of age, along with Pap smears, every 5 years.

The HPV DNA test is not recommended for screening women younger than age 30 because infections with HPV are relatively common in this age group and often resolve without treatment or complications. However, it may be used as a follow-up test in women who are 21 years or older who have abnormal results on a Pap smear known as "atypical squamous cells of undetermined significance" (ASCUS) [see Pap Smear Terminology]. Results may be used to determine the need for colposcopy, a procedure that allows a doctor to visually inspect the vagina and cervix under magnification for the presence of abnormal cells.

Some doctors will test men who fall into a high-risk category. Men who have sex with men and those who have HIV may be tested for HPV. Evaluating the risk of HPV-related diseases of the anal canal in men is becoming more common.

What does the test result mean?

On a Pap smear, ASCUS and low-grade changes indicate the likely presence of HPV and the need for further testing. A positive HPV DNA test indicates the presence of a high-risk type of HPV, but the test does not specify which type is present. If the HPV DNA test is negative, it is unlikely that there is a high-risk HPV infection. If the Pap smear is abnormal but the HPV DNA test is negative, then follow-up testing and further monitoring are indicated. The Centers for Disease Control and Prevention says to wait three years before getting another Pap smear and HPV test and to talk to the doctor about when to come in for another visit. Likewise, if the Pap smear is normal but the HPV DNA test is positive, additional testing may be necessary. It is recommended to have another Pap smear and HPV test in one year, at which point the Pap smear will indicate if any cell changes have occurred during that time.

The tests most commonly used to screen for HPV only detect those types that have a higher risk of progressing to cancer. If positive, they indicate the presence of one of these high-risk types:

HPV types 16, 18, 31, 33, 39, 45, 51, 52, 56, 58, 59, 66, 68, and 73

Sometimes, molecular tests to detect and identify low-risk HPV types are ordered. If the result is positive, it indicates the presence of one of the low-risk types:

A test approved by the FDA in 2009 identifies the specific HPV subtypes 16 and 18. If this test is positive, it indicates the presence of subtypes that cause 70% of cervical cancer. A second DNA test, also approved in 2009, detects essentially all of the high-risk HPV types in cervical cell samples.

A doctor might take a small piece of tissue (a biopsy) from the cervix and examine it under a microscope. When either the Pap smear or the biopsy indicates a condition that could lead to cancer (called intraepithelial neoplasia), an HPV DNA test can determine if the patient is infected with a high-risk strain of HPV that increases the chance that cancer might develop if not treated.

Some doctors test men who are at high risk for sexually transmitted diseases for HPV-related anal cancer. Such testing is similar to a cervical Pap smear. The anal lining is swabbed and the cells are examined under a microscope. HPV DNA tests can also be performed on these samples. As in cervical samples, positive results will need to be followed up by the doctor with further testing, including a more thorough exam and possible biopsy.

Is there anything else I should know?

Although very rare, a pregnant woman may pass HPV to her baby during vaginal delivery, resulting in warts in the throat or voice box (laryngeal papillomatosis or recurrent respiratory papillomatosis, RRP).

1. How is HPV treated?

There is no treatment for the virus itself, but the body's immune system is usually able to fight it off within a few years. There are treatments, however, for the diseases the virus causes. Genital warts can be removed using chemicals, by freezing them or burning them off electrically, or via surgery or lasers. For most people, this treatment will clear the warts. If warts return repeatedly, the doctor may try injecting them with the drug interferon. Untreated genital warts can disappear on their own, stay the same, or grow in size and number and cluster in large masses.

Abnormal Pap smears can be treated in a variety of ways, from monitoring over a period of months to see if they return to normal, to cryosurgery that freezes and destroys infected cells in the cervix, to surgical removal of problem tissue. Catching cervical changes early is the key to avoiding cervical cancer, which is more difficult to treat.

2. How can HPV be prevented?

The Food and Drug Administration (FDA) has approved two vaccines that protect against HPV types 16 and 18, which cause 70% of cervical cancers. One of the vaccines also protects against types 6 and 11, which cause about 90% of genital warts. The FDA has approved both vaccines for use in girls and women 9 to 26 years old, and the second vaccine for prevention of genital warts in boys and men 9 through 26 years old. The vaccines are given in three doses over a period of six months.

The American Academy of Pediatrics recommends that both girls and boys receive HPV vaccines between ages 11 and 12 and that those age 13 to 21 who haven't had the vaccine be immunized.

The FDA says the vaccines are considered safe but are only effective if given before an initial exposure to the virus. AAP recommends that young people who are sexually active still receive the vaccination as those already infected with one type of HPV infection may benefit from the protection against other types included in the vaccine.

3. Are men screened for HPV infection?

Men are not routinely screened for HPV infection unless they fall into a category at high risk for cancer, such as those with compromised immune systems or who have sex with men. Currently, there are no tests approved by the Food and Drug Administration (FDA) to detect HPV in males; however, some specialty labs have validated DNA tests for analyzing anal swabs from males.

4. I'm a woman who has had the HPV vaccine. Do I need cervical cancer screening?

5. Other than HPV, what are other risk factors for cervical cancer in women?

According to the National Cancer Institute, certain factors can further raise cervical cancer risk after an HPV infection. These include having many children, long-term oral contraceptive use, and chronic inflammation.

Increased risk is also associated with beginning sexual intercourse at an early age, having multiple sexual partners, infrequent Pap smears, smoking, a history of DES exposure, previous diagnosis of cervical cancer, compromised immune system from organ transplant or HIV, and the presence of other sexually transmitted diseases such as herpes.

Article Sources

NOTE: This article is based on research that utilizes the sources cited here as well as the collective experience of the Lab Tests Online Editorial Review Board. This article is periodically reviewed by the Editorial Board and may be updated as a result of the review. Any new sources cited will be added to the list and distinguished from the original sources used.

Sources Used in Current Review

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American College of Obstetricians and Gynecologists (ACOG). Cervical cytology screening. Washington (DC): American College of Obstetricians and Gynecologists (ACOG); 2009 Dec. 12 (ACOG practice bulletin; no. 109). Available online at http://www.guideline.gov/content.aspx?id=15274#Section420 through http://www.guideline.gov. Accessed March 23, 2012

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Sources Used in Previous Reviews

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This article was last reviewed on June 13, 2012. | This article was last modified on February 12, 2015.

The review date indicates when the article was last reviewed from beginning to end to ensure that it reflects the most current science. A review may not require any modifications to the article, so the two dates may not always agree.

The modified date indicates that one or more changes were made to the article. Such changes may or may not result from a full review of the article, so the two dates may not always agree.